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Relapse after allogeneic transplantation with post-transplant cyclophosphamide: Shattering myths and evolving insight.
McCurdy, Shannon R; Luznik, Leo.
Afiliação
  • McCurdy SR; Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: shannon.mccurdy@pennmedicine.upenn.edu.
  • Luznik L; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Blood Rev ; 62: 101093, 2023 11.
Article em En | MEDLINE | ID: mdl-37198064
Early studies in allogeneic blood or marrow transplantation (alloBMT) demonstrated that HLA-mismatching was protective again relapse. However, benefits in relapse reduction were outweighed by a high risk of graft-versus-host disease (GVHD) when using conventional pharmacological immunosuppression. Post-transplant cyclophosphamide(PTCy)-based platforms abated the risk of GVHD thereby overcoming the negative effects of HLA-mismatching on survival. However, since its inception, PTCy has been shadowed by a reputation for a greater risk of relapse when compared with traditional GVHD prophylaxis. Specifically, whether PTCy reduces the anti-tumor efficacy of HLA-mismatched alloBMT by killing alloreactive T cells has been the subject of debate since the early 2000's. Here we review the many studies demonstrating the potent graft-versus-malignancy (GVM) properties of alloBMT with PTCy. We discuss the laboratory data from PTCy platforms supporting that T regulatory cells may be a major mechanism of prevention of GVHD and that natural killer (NK) cells may be early effectors of GVM. Finally, we propose potential paths to optimize GVM through selecting for class II mismatching and augmenting NK cell activity.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Transplante de Células-Tronco Hematopoéticas / Doença Enxerto-Hospedeiro Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Transplante de Células-Tronco Hematopoéticas / Doença Enxerto-Hospedeiro Idioma: En Ano de publicação: 2023 Tipo de documento: Article